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Movement Matters, and So Does Context: Lessons Learned From Multisite Implementation of the Movement Matters Activity Program for Stroke in the Comprehensive Postacute Stroke Services Study

Published:October 22, 2020DOI:https://doi.org/10.1016/j.apmr.2020.09.386

      Highlights

      • Comprehensive Postacute Stroke Services (COMPASS) is a large pragmatic trial of comprehensive postacute stroke services.
      • The Movement Matters Activity Program (MMAP) is a key COMPASS model intervention.
      • The MMAP promotes evidence-based poststroke rehabilitative care in the community.
      • The MMAP implementation in home health and outpatient therapy was highly variable.
      • Keys to success: empowered leaders, informed clinicians, value-based care emphasis.

      Abstract

      The purpose of this Special Communication is to discuss the rationale and design of the Movement Matters Activity Program for Stroke (MMAP) and explore implementation successes and challenges in home health and outpatient therapy practices across the stroke belt state of North Carolina. MMAP is an interventional component of the Comprehensive Postacute Stroke Services Study, a randomized multicenter pragmatic trial of stroke transitional care. MMAP was designed to maximize survivor health, recovery, and functional independence in the community and to promote evidence-based rehabilitative care. MMAP provided training, tools, and resources to enable rehabilitation providers to (1) prescribe physical activity and exercise according to evidence-based guidelines and programs, (2) match service setting and parameters with survivor function and benefit coverage, and (3) align treatment with quality metric reporting to demonstrate value-based care. MMAP implementation strategies were aligned with the Expert Recommendations for Implementing Change project, and MMAP site champion and facilitator survey feedback were thematically organized into the Consolidated Framework for Implementation Research domains. MMAP implementation was challenging, required modification and was affected by provider- and system-level factors. Program and study participation were limited and affected by practice priorities, productivity standards, and stroke patient volume. Sites with successful implementation appeared to have empowered MMAP champions in vertically integrated systems that embraced innovation. Findings from this broad evaluation can serve as a road map for the design and implementation of other comprehensive, complex interventions that aim to bridge the currently disconnected realms of acute care, postacute care, and community resources.

      Graphical abstract

      Keywords

      List of abbreviations:

      APP (Advanced Practice Provider), CFIR (Consolidated Framework for Implementation Research), COMPASS (Comprehensive Postacute Stroke Services), COMPASS-CP (Comprehensive Postacute Stroke Services Care Plan), CMS (Centers for Medicare and Medicaid Services), EBP (evidence-based practice), MMAP (Movement Matters Activity Program), PAC (postacute care), TC (transitional care), TIA (transient ischemic attack)
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